Background: Early neonatal morbidity and mortality represents a major problem caused by maternal medical and obstetric risk factors complicated by lack of primary antenatal care. High risk pregnancy is known to negatively affect the neonatal outcomes. Aim of the Work:This study aimed to compare low and high risk pregnancy neonatal outcomes and to test individual maternal risk factors for poor neonatal outcomes. Patients and Methods:A retrospective study was conducted at a tertiary referral hospital over 6 months. After applying eligibility criteria, 157 high and 125 low risk patients were identified. The neonatal outcome measures were weight, sex, Apgar score at 1 and 5 minutes, respiratory distress, neonatal intensive care unit admission, endotracheal intubation, mechanical ventilation, meconium aspiration and neonatal death.Results: Neonatal morbidity was higher in high risk group (p<0.05). The Relative Risk of low birth weight, poor Apgar score at 1 minute, respiratory distress, neonatal intensive care unit admission, endotracheal intubation and mechanical ventilation was 8. 2, 1.85, 5.13, 6.83, 15.37 and 26.42 respectively emphasizing that prematurity affected early neonatal outcomes. Conclusion:The main determinants of poor neonatal outcomes were preterm delivery, previous section and hypertensive disorders.